Provider Demographics
NPI:1972776680
Name:NEAL, KRISTIN ANN (PA-C)
Entity Type:Individual
Prefix:
First Name:KRISTIN
Middle Name:ANN
Last Name:NEAL
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11001 N BLACK CANYON HWY
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85029-4757
Mailing Address - Country:US
Mailing Address - Phone:602-942-4462
Mailing Address - Fax:
Practice Address - Street 1:7609 E PINNACLE PEAK RD
Practice Address - Street 2:SUITE 9
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85255-3415
Practice Address - Country:US
Practice Address - Phone:480-585-0095
Practice Address - Fax:480-585-0185
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-02
Last Update Date:2009-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ2221363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant